Affecting around 1-4% of the worldwide population, bipolar disorder (BD) is a mental health condition that causes acute mood swings and unusual shifts in energy. Individuals dealing with BD can experience periods of extreme highs (often called “mania” or “manic episodes”) and intense lows (“major depressive episodes” or “major depression”). These periods can last for days or weeks and are called mood episodes.
While it’s still unknown what causes BD and how family history plays a role, the good news is that help is available to manage its symptoms.
Here’s everything you need to know about the different types of bipolar disorder, what causes it, bipolar disorder symptoms and warning signs, and how this mental health condition can be treated.
Types of Bipolar Disorder
There are three diagnoses for bipolar disorder: bipolar I, bipolar II, and cyclothymic disorder. Here’s how each of the conditions is characterized.
Bipolar I
Bipolar I disorder is characterized by at least one manic episode that might be preceded or followed by a depressive or hypomanic episode. People with bipolar I also experience periods of neutral mood.
A manic episode is classified as lasting for at least one week. In contrast, a hypomanic episode should last for four straight days. A depressive episode should last at least two weeks and include several symptoms, such as intense sadness or despair and increased or decreased sleep.
Bipolar II
Not to be mistaken as a milder version of bipolar I, bipolar II disorder is a separate diagnosis marked by at least one major depressive episode and at least one hypomanic episode, but never any episodes of mania. Between these depressive and hypomanic episodes, people tend to return to their regular functioning.
The manic episodes in those dealing with bipolar I can be just as challenging as the longer depressive episodes of bipolar II. Also, people with bipolar II often deal with other mental conditions, such as anxiety disorders, ADHD, or substance abuse disorders.
Cyclothymic Disorder
Cyclothymic disorder, also called cyclothymia, is characterized by at least two years of many periods of hypomania depressive symptoms that are less severe than major depression. During these two years, the symptoms should have continued for at least half that time and not ceased for over two months.
Other Types of Bipolar Disorder
Suppose the symptoms and mood changes an individual is experiencing — such as clinically significant abnormal mood elevation — don’t match the criteria for bipolar I, bipolar II, or cyclothymic disorder. In that case, their condition is classified as “other specified” or “unspecified bipolar and related disorders.”
A person may receive other diagnoses if their symptoms match bipolar I and II but also express other symptoms. For example, there is rapid cycling bipolar disorder, whereby an individual has bipolar I or II and has experienced four or more episodes of depression, mania, or hypomania in one year.
There’s also bipolar I or II with mixed symptoms. Individuals may receive this diagnosis if they experience depression, mania, or hypomania simultaneously or quickly following each other.
Finally, there’s a subtype of bipolar disorder called seasonal affective disorder (SAD) where a person experiences symptoms of either major depressive disorder or bipolar disorder during just a few months of the year. Individuals with SAD and underlying bipolar tend to have alternating episodes of depression in the fall and winter, and mania during the spring and summer.
Causes of Bipolar Disorder
While the exact cause of bipolar disorder is unknown, researchers have explored possible causes. From neurological and genetic reasons to potential psychological and life-related risk factors, here are some of the possible elements behind the onset of bipolar disorder.
Neurological Differences
Although the causes of bipolar disorder are still uncertain, people with bipolar disorder do appear to have differences in the brain.
Neuroimaging — a process that uses various techniques to produce images of the brain to study the structure and function of the central nervous system — shows that people with bipolar have shown to carry connectivity dysfunctions in the neural circuits that handle emotion processing, emotion regulation, and reward processing.
Genetics
The average age for when symptoms start to show in someone who has bipolar disorder is 25, and it’s a highly heritable disorder. Having a first-degree relative, such as a parent or sibling, with bipolar can increase an individual’s chance of having it. Research is still ongoing on specific genes that may be involved in causing bipolar disorder.
Risk Factors
Specific triggers may bring on symptoms of bipolar disorder, such as “life-changing events, bullying, and even changes in the weather,” says Grow Therapy’s JohnNeiska Williams, a Licensed Professional Counselor (LPC) specializing in treating bipolar disorder. Here are some other risk factors that might trigger BD symptoms.
- Periods of high stress, such as the death of a loved one or the breakdown of a relationship
- Physical, sexual, or emotional abuse
- Physical illness
- Sleep disturbances
- Overwhelming problems in day-to-day life
According to Williams, if the symptoms triggered by any of these risk factors last longer than 24 months, or if periods of depressive symptoms or mania become more frequent and intense, it should be taken seriously, and a mental health provider might need to be considered.
Signs and Symptoms
Bipolar disorder is distinguished by the extreme mood swings it produces. Those dealing with BD generally experience intense highs and lows, along with the following symptoms and behavioral changes.
Mania and Hypomania
A manic episode is described as a period of one week when an individual is extremely high-spirited or in an irritable mood for most of the days in that week. They may also have more energy than usual and display at least three of the following changes in behavior:
- Decreased need for sleep
- Talking more and faster than usual
- Uncontrollable racing thoughts
- Quickly changing topics when speaking
- Easily distracted
- Increased activity, such as restlessness or working on several projects at once
- Increased participation in risky behavior, such as dangerous driving and spending sprees
“Manic symptoms can range between manic or hypomanic. Some of the manic symptoms tend to be a little more intense or aggressive than hypomanic symptoms,” explains Williams.
“Manic behaviors and symptoms may include violence, drugs, alcohol, sex, delusions, psychosis, hallucinations, and paranoia. Some hypomanic behaviors and symptoms could be obsessions, impulsiveness, excessive spending habits, distractions, and a decreased need for sleep.”
People with BD also can experience psychosis — defined as delusions or hallucinations — during their manic episodes.
Major Depressive Episodes
A major depressive episode is classed as a period of two weeks during which an individual displays at least five of the following symptoms of depression, including at least one of the first two symptoms:
- Intense sadness or despair
- Loss of interest in activities the person once enjoyed
- Feelings of worthlessness or guilt
- Fatigue
- Sleeping more or less than usual
- Eating more or less than usual
- Restlessness, slowed speech or movement
- Difficulty concentrating
- Frequent thoughts of death or suicide
Treatment Options
If you think you or someone you know is showing signs of bipolar disorder, seeking an accurate diagnosis is essential to receive proper treatment.
“There are several test instruments that can be used in the diagnosis of bipolar disorder,” adds Williams. “The most common, and my favorite, is the Mood Disorder Questionnaire. I also assess whether there have been long periods of depression and manic or hypomanic symptoms. Most times, with the diagnosis of bipolar disorder, these symptoms have existed for more than two years.”
Once a diagnosis has been reached, there are effective treatment options available.
Therapy
Psychotherapy (sometimes called talk therapy), cognitive behavioral therapy (CBT), and family-focused therapy (FFT) are types of therapy that have been shown to effectively treat and manage bipolar disorder when used in conjunction with medication.
CBT focuses on helping people with bipolar disorder recognize negative thoughts and teaching them coping strategies. In contrast, psychotherapy focuses on self-care and stress regulation. Lastly, family-focused therapy (FFT) is a psycho-educational treatment that focuses on the alleviation of mood symptoms, relapse prevention, and enhancing psychosocial functioning. One of the main goals of FFT is to teach patients and their family members about the nature of bipolar disorder.
Williams says, “Therapy is very important when working with BD. Even when it becomes manageable, it’s important to have a ‘mental health check-up,’ where you assess whether the transitions between moods and episodes are still manageable on your own.”
What a person with bipolar disorder can expect from therapy depends on the individual, the type of bipolar disorder, and the clinician’s approach to therapy, advises Williams. “For example, when I work with clients that are diagnosed with bipolar II, I use prolonged exposure (PE) therapy or exposure therapy in general. Therapy with me focuses a lot on awareness, relabeling, and reframing behaviors by re-exposing clients to the stress and learning to ground themselves in a counterintuitive way.”
Support groups may also be another great way for someone to share their bipolar disorder experience with others who are going through something similar.
Find a therapist for bipolar disorder
Medication
Lithium is prescribed to a person dealing with bipolar disorder to help stabilize their mood and prevent the extreme highs and lows that come with BD.
Anticonvulsants — medications used to treat seizures such as divalproex sodium, carbamazepine, and lamotrigine — are also used as mood stabilizers and are often recommended for people dealing with bipolar.
Second-generation antipsychotics (SGAs) are commonly prescribed to help control acute episodes of mania or depression. SGAs are often used alongside other medications, including mood stabilizers.
Interestingly, when it comes to antidepressants, a medication that many might think is suitable for treating bipolar disorder, there’s some controversy. While they might be effective in treating the symptoms of bipolar depression, they can trigger mania in some people, so antidepressants aren’t considered top of the list when it comes to treating BD.
Electroconvulsive Therapy (ECT)
In rare, severe cases of mania or depression, ECT is highly effective but is only reserved as a last-resort BD treatment when nothing else has worked.
ECT transmits short, electrical impulses to the brain to induce a seizure. While it’s unclear why this method is effective for treating bipolar disorder, it may be linked to its ability to change a person’s brain chemistry, easing BD symptoms.
Key Takeaways
With the right tools, support, and long-term treatment, people with bipolar disorder can live full and happy lives while managing their symptoms.
Williams says, “People with bipolar disorder can live normal lives once it’s managed. I have a motto: several situations can cause the same feeling; however, several feelings can’t come from the same situation. Once we manage the feeling of one situation, we can manage the feelings of several others. People with BD who adopt this motto tend to live normal lives because they’re aware of their feelings, behaviors, and patterns of their BD and are able to plan a more positive approach to handling it, rather than being impulsive and allowing their bodies to react before they think.”
At Grow Therapy, we have excellent, qualified therapists who specialize in dealing with bipolar disorder. So, if you or anyone you know are looking for mental health support, try searching our marketplace to find a therapist who’s right for you.
